| NPI | 1104828318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME50892) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0050892) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-02-08 |